mkdir -p /home/daytona/workspace/acs-ppt && ls /home/daytona/workspace/acs-ppt/

~/acs-ppt/create_acs_ppt.js

const pptxgen = require("pptxgenjs");

const pres = new pptxgen();
pres.layout = "LAYOUT_16x9";
pres.title = "Acute Compartment Syndrome";
pres.author = "Medical Education";

// ─── COLOUR PALETTE ───────────────────────────────────────────────
const C = {
  darkBg:    "0D1B2A",   // deep navy – title / section slides
  midBg:     "1B2A3B",   // darker navy
  accent:    "E63946",   // vivid red (danger / urgency)
  accentAmb: "F4A261",   // amber – warning
  accentGrn: "2A9D8F",   // teal-green – treatment
  white:     "FFFFFF",
  lightGray: "D1D5DB",
  textDark:  "1F2937",
  cardBg:    "F0F4F8",
  divider:   "E63946",
  slideNum:  "A8B2BE",
};

// ─── HELPER: slide number footer ──────────────────────────────────
function addFooter(slide, num, total) {
  slide.addText(`${num} / ${total}`, {
    x: 9.2, y: 5.3, w: 0.6, h: 0.25,
    fontSize: 9, color: C.slideNum, align: "right",
  });
}

// ─── HELPER: section-label pill ───────────────────────────────────
function addPill(slide, label, color) {
  slide.addShape(pres.ShapeType.roundRect, {
    x: 0.35, y: 0.22, w: 1.7, h: 0.28,
    fill: { color: color || C.accent }, line: { color: color || C.accent },
    rectRadius: 0.05,
  });
  slide.addText(label, {
    x: 0.35, y: 0.22, w: 1.7, h: 0.28,
    fontSize: 8.5, bold: true, color: C.white, align: "center", valign: "middle",
    margin: 0,
  });
}

// ─── HELPER: content slide skeleton ───────────────────────────────
function contentSlide(title, pillLabel, pillColor) {
  const slide = pres.addSlide();
  // left red accent bar
  slide.addShape(pres.ShapeType.rect, {
    x: 0, y: 0, w: 0.12, h: 5.625,
    fill: { color: C.accent }, line: { color: C.accent },
  });
  // heading underline strip
  slide.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 0.65, w: 9.5, h: 0.04,
    fill: { color: C.accent }, line: { color: C.accent },
  });
  if (pillLabel) addPill(slide, pillLabel, pillColor);
  slide.addText(title, {
    x: 0.25, y: 0.1, w: 9.5, h: 0.55,
    fontSize: 20, bold: true, color: C.textDark, valign: "middle",
    fontFace: "Calibri",
  });
  return slide;
}

// ─── HELPER: card ─────────────────────────────────────────────────
function addCard(slide, x, y, w, h, headerText, headerColor, bodyLines) {
  // header
  slide.addShape(pres.ShapeType.rect, {
    x, y, w, h: 0.35,
    fill: { color: headerColor }, line: { color: headerColor },
  });
  slide.addText(headerText, {
    x: x + 0.08, y, w: w - 0.1, h: 0.35,
    fontSize: 11, bold: true, color: C.white, valign: "middle", margin: 0,
  });
  // body
  slide.addShape(pres.ShapeType.rect, {
    x, y: y + 0.35, w, h: h - 0.35,
    fill: { color: C.cardBg }, line: { color: "CBD5E1", size: 1 },
  });
  const items = bodyLines.map((t, i) => ({
    text: t,
    options: { bullet: { type: "bullet" }, breakLine: i < bodyLines.length - 1, fontSize: 10.5, color: C.textDark },
  }));
  slide.addText(items, {
    x: x + 0.12, y: y + 0.42, w: w - 0.2, h: h - 0.55,
    valign: "top", fontFace: "Calibri",
  });
}

const TOTAL = 14;

// ══════════════════════════════════════════════════════════════════
// SLIDE 1 – TITLE SLIDE
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.darkBg };
  // diagonal red accent shape
  s.addShape(pres.ShapeType.rect, {
    x: 0, y: 3.8, w: 10, h: 1.825,
    fill: { color: C.accent }, line: { color: C.accent },
  });
  // thin amber stripe
  s.addShape(pres.ShapeType.rect, {
    x: 0, y: 3.72, w: 10, h: 0.08,
    fill: { color: C.accentAmb }, line: { color: C.accentAmb },
  });
  s.addText("ACUTE COMPARTMENT SYNDROME", {
    x: 0.5, y: 0.6, w: 9, h: 1.2,
    fontSize: 38, bold: true, color: C.white, align: "center",
    fontFace: "Calibri", charSpacing: 2,
  });
  s.addText("A Surgical Emergency", {
    x: 0.5, y: 1.9, w: 9, h: 0.6,
    fontSize: 22, color: C.accentAmb, align: "center", italic: true, fontFace: "Calibri",
  });
  s.addText("Diagnosis · Pathophysiology · Management", {
    x: 0.5, y: 2.6, w: 9, h: 0.5,
    fontSize: 14, color: C.lightGray, align: "center", fontFace: "Calibri",
  });
  s.addText("Sources: Bailey & Love's Surgery 28e  |  Current Surgical Therapy 14e  |  Rosen's Emergency Medicine", {
    x: 0.5, y: 4.0, w: 9, h: 0.5,
    fontSize: 9, color: C.white, align: "center", fontFace: "Calibri",
  });
  addFooter(s, 1, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 2 – DEFINITION & OVERVIEW
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Definition & Overview", "OVERVIEW", C.textDark);
  s.addText([
    { text: "Compartment syndrome", options: { bold: true, color: C.accent } },
    { text: " is raised pressure within a ", options: {} },
    { text: "closed fascial compartment", options: { bold: true } },
    { text: " that compromises tissue perfusion, leading to ischaemia and irreversible muscle damage.", options: {} },
  ], {
    x: 0.25, y: 0.8, w: 9.5, h: 0.8,
    fontSize: 14, color: C.textDark, fontFace: "Calibri",
  });

  // 3 info boxes
  const boxes = [
    { x: 0.25, col: C.accent,    title: "Causes",          lines: ["Fractures (70%)", "Soft-tissue contusion (23%)", "Tight casts / dressings", "Burns (circumferential)", "Reperfusion / post-ischaemic", "Bleeding disorders / anticoagulation", "IV extravasation under pressure"] },
    { x: 3.55, col: C.accentAmb, title: "Pathophysiology",  lines: ["↑ Tissue pressure", "→ ↓ Microperfusion", "→ Tissue ischaemia", "→ Cellular anoxia", "→ Irreversible muscle necrosis", "Vicious cycle of oedema & pressure"] },
    { x: 6.85, col: C.accentGrn, title: "Key Concept",      lines: ["A time-critical emergency", "Minutes to hours matter", "Can occur in OPEN fractures", "Equal incidence: high-energy vs low-energy injuries", "Requires urgent fasciotomy"] },
  ];
  boxes.forEach(b => addCard(s, b.x, 1.75, 3.1, 3.5, b.title, b.col, b.lines));
  addFooter(s, 2, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 3 – ANATOMY OF COMPARTMENTS
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Anatomy of Compartments", "ANATOMY", C.accentGrn);

  // Leg compartments box
  addCard(s, 0.25, 0.78, 4.5, 2.2, "Lower Leg (4 Compartments)", C.accentGrn, [
    "Anterior – tibialis anterior, EHL, EDB, deep peroneal n.",
    "Lateral – peroneus longus & brevis, superficial peroneal n.",
    "Superficial posterior – gastrocnemius, soleus, sural n.",
    "Deep posterior – FHL, FDL, tibialis posterior, posterior tibial n.",
  ]);

  // Forearm compartments box
  addCard(s, 0.25, 3.1, 4.5, 2.2, "Forearm (3 Compartments)", C.accent, [
    "Volar superficial – wrist & finger flexors",
    "Volar deep – FDP, FPL, pronator quadratus",
    "Dorsal – wrist & finger extensors",
  ]);

  // image from textbook
  s.addImage({
    path: "/home/daytona/workspace/acs-ppt/compartment_diagram.png",
    x: 4.95, y: 0.78, w: 4.85, h: 4.6,
    sizing: { type: "contain", w: 4.85, h: 4.6 },
  });

  addFooter(s, 3, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 4 – CLINICAL FEATURES
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Clinical Features — The 6 P's", "DIAGNOSIS", C.accent);

  // 6-P grid
  const Ps = [
    { label: "Pain",         desc: "Out of proportion to injury\nEarliest & most reliable sign", col: C.accent },
    { label: "Pressure",     desc: "Tensely swollen, woody-hard compartment", col: C.accent },
    { label: "Paraesthesia", desc: "Numbness / tingling in the distribution of nerves in that compartment", col: C.accentAmb },
    { label: "Pain on Passive\nStretch", desc: "Key clinical test — stretching the muscles ↑ pain dramatically", col: C.accentAmb },
    { label: "Paralysis",    desc: "Motor weakness – LATE sign indicating nerve/muscle damage", col: "6B7280" },
    { label: "Pulselessness",desc: "EXTREMELY late sign – arterial occlusion not needed for ACS", col: "6B7280" },
  ];

  const cols = [0.25, 3.4, 6.55];
  const rows = [0.82, 2.8];
  Ps.forEach((p, i) => {
    const x = cols[i % 3];
    const y = rows[Math.floor(i / 3)];
    // card header
    s.addShape(pres.ShapeType.roundRect, {
      x, y, w: 2.9, h: 1.75,
      fill: { color: i < 4 ? C.cardBg : "F9FAFB" },
      line: { color: p.col, size: 2 }, rectRadius: 0.06,
    });
    s.addShape(pres.ShapeType.roundRect, {
      x, y, w: 2.9, h: 0.4,
      fill: { color: p.col }, line: { color: p.col }, rectRadius: 0.06,
    });
    s.addText(p.label, {
      x: x + 0.08, y, w: 2.74, h: 0.4,
      fontSize: 12, bold: true, color: C.white, valign: "middle", margin: 0,
    });
    s.addText(p.desc, {
      x: x + 0.1, y: y + 0.45, w: 2.7, h: 1.25,
      fontSize: 10.5, color: C.textDark, valign: "top", fontFace: "Calibri",
    });
  });

  // early vs late callout
  s.addText("Early signs: Pain, Pressure, Paraesthesia, Pain on stretch   |   Late signs: Paralysis, Pulselessness", {
    x: 0.25, y: 5.1, w: 9.5, h: 0.32,
    fontSize: 9.5, color: C.white, align: "center", bold: true,
    fill: { color: C.accent },
  });

  addFooter(s, 4, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 5 – DIAGNOSIS
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Diagnosis", "DIAGNOSIS", C.accent);

  // Clinical diagnosis box
  s.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 0.78, w: 4.55, h: 2.0,
    fill: { color: "FFF5F5" }, line: { color: C.accent, size: 2 },
  });
  s.addText("Clinical Diagnosis (Primary)", {
    x: 0.35, y: 0.82, w: 4.3, h: 0.38,
    fontSize: 12, bold: true, color: C.accent, fontFace: "Calibri",
  });
  s.addText([
    { text: "• Pain out of proportion to injury\n", options: { breakLine: false } },
    { text: "• Increasing pain over time\n", options: { breakLine: false } },
    { text: "• Pain on passive muscle stretch\n", options: { breakLine: false } },
    { text: "• Paraesthesia in the compartment\n", options: { breakLine: false } },
    { text: "• Tense, woody compartment on palpation", options: {} },
  ], {
    x: 0.35, y: 1.28, w: 4.3, h: 1.4,
    fontSize: 10.5, color: C.textDark, fontFace: "Calibri",
  });

  // Pressure measurement box
  s.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 2.9, w: 4.55, h: 2.4,
    fill: { color: "FFFBF0" }, line: { color: C.accentAmb, size: 2 },
  });
  s.addText("Compartment Pressure Monitoring", {
    x: 0.35, y: 2.94, w: 4.3, h: 0.38,
    fontSize: 12, bold: true, color: C.accentAmb, fontFace: "Calibri",
  });
  s.addText([
    { text: "Indicated when:\n", options: { bold: true } },
    { text: "• Diagnostic uncertainty\n• Altered consciousness (intubated, head injury)\n• Uncooperative / sedated patient\n\n", options: {} },
    { text: "Thresholds for fasciotomy:\n", options: { bold: true } },
    { text: "• Absolute pressure ≥ 30 mmHg\n• ΔP (diastolic − compartment) ≤ 30 mmHg\n• Some advocate ΔP < 10 mmHg", options: {} },
  ], {
    x: 0.35, y: 3.38, w: 4.3, h: 1.85,
    fontSize: 10.5, color: C.textDark, fontFace: "Calibri",
  });

  // Important notes
  addCard(s, 5.05, 0.78, 4.7, 2.1, "Pitfalls to Avoid", C.accent, [
    "ACS can occur in OPEN fractures",
    "Pulselessness is NOT required for diagnosis",
    "High- and low-energy injuries carry equal risk",
    "Elevated CPK / myoglobinuria = LATE marker; do not wait",
    "Maintain high index of suspicion in all limb injuries",
  ]);

  // Differential
  addCard(s, 5.05, 3.0, 4.7, 2.3, "Differential Diagnosis", C.textDark, [
    "Deep vein thrombosis (DVT)",
    "Cellulitis / necrotizing fasciitis",
    "Peripheral arterial occlusion",
    "Rhabdomyolysis without ACS",
    "Severe muscle contusion / haematoma",
  ]);

  addFooter(s, 5, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 6 – MANAGEMENT OVERVIEW
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Management — Overview", "MANAGEMENT", C.accentGrn);

  // 3-step flow
  const steps = [
    { num: "1", title: "Immediate First Aid", col: C.accentAmb, items: [
      "Remove ALL constricting casts, bandages, dressings",
      "Split cast to the skin (bivalve cast)",
      "Elevate extremity to heart level (NOT above)",
      "Give adequate analgesia",
      "Correct hypotension / optimise MAP",
    ]},
    { num: "2", title: "Surgical Fasciotomy", col: C.accent, items: [
      "Definitive treatment – do NOT delay",
      "Lower leg: 4-compartment via medial + lateral incisions",
      "Forearm: Volar + dorsal release",
      "Hand: Carpal tunnel ± hand fasciotomies if needed",
      "Leave wounds OPEN – do NOT close primarily",
    ]},
    { num: "3", title: "Post-Fasciotomy Care", col: C.accentGrn, items: [
      "Vacuum-assisted closure (VAC) device",
      "Serial wound inspections every 48–72 hrs",
      "Delayed primary closure / split-thickness skin graft",
      "Monitor for rhabdomyolysis (urine output, CPK, creatinine)",
      "IV hydration: target UO > 100 mL/hr until CPK < 5000 U/L",
    ]},
  ];

  steps.forEach((st, i) => {
    const x = 0.25 + i * 3.2;
    // circle number
    s.addShape(pres.ShapeType.ellipse, {
      x: x + 1.1, y: 0.78, w: 0.9, h: 0.9,
      fill: { color: st.col }, line: { color: st.col },
    });
    s.addText(st.num, {
      x: x + 1.1, y: 0.78, w: 0.9, h: 0.9,
      fontSize: 24, bold: true, color: C.white, align: "center", valign: "middle", margin: 0,
    });
    addCard(s, x, 1.75, 3.0, 3.55, st.title, st.col, st.items);
  });

  // flow arrows between steps
  [1, 2].forEach(i => {
    s.addShape(pres.ShapeType.rightArrow, {
      x: 0.25 + i * 3.2 - 0.32, y: 3.3, w: 0.32, h: 0.5,
      fill: { color: C.lightGray }, line: { color: C.lightGray },
    });
  });

  addFooter(s, 6, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 7 – FASCIOTOMY TECHNIQUES
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Fasciotomy Techniques", "SURGERY", C.accent);

  addCard(s, 0.25, 0.78, 4.6, 2.3, "Lower Leg – 4 Compartment Release", C.accent, [
    "TWO longitudinal incisions",
    "LATERAL: release anterior + lateral compartments",
    "MEDIAL: release superficial + deep posterior compartments",
    "Incisions 15–20 cm in length",
    "Ensure complete skin release – no partial decompression",
  ]);

  addCard(s, 0.25, 3.2, 4.6, 2.1, "Forearm Release", C.accentAmb, [
    "Volar incision: release superficial & deep volar compartments",
    "Dorsal incision: release dorsal compartment",
    "Extend to carpal tunnel if hand swelling present",
    "Consult hand surgery for digital fasciotomies",
  ]);

  addCard(s, 5.1, 0.78, 4.6, 2.3, "Wound Management", C.accentGrn, [
    "Wounds left OPEN post-fasciotomy",
    "VAC (vacuum-assisted closure) applied",
    "Reduces muscle oedema and promotes granulation",
    "Closure at 5–7 days if swelling resolves",
    "Split-thickness skin graft (STSG) if unable to close primarily",
  ]);

  addCard(s, 5.1, 3.2, 4.6, 2.1, "Key Warnings", C.accent, [
    "Incomplete skin release = muscle necrosis risk",
    "Early closure attempts must be AVOIDED",
    "Fasciotomy can be required for open fractures too",
    "Prophylactic fasciotomy for ischaemia > 6 hours",
  ]);

  addFooter(s, 7, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 8 – RHABDOMYOLYSIS & SYSTEMIC COMPLICATIONS
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Systemic Complications — Rhabdomyolysis", "COMPLICATIONS", C.accentAmb);

  s.addText("Muscle necrosis releases myoglobin into the circulation, leading to a cascade of systemic complications.", {
    x: 0.25, y: 0.82, w: 9.5, h: 0.5,
    fontSize: 12, color: C.textDark, italic: true, fontFace: "Calibri",
  });

  const comp = [
    { title: "Rhabdomyolysis", col: C.accentAmb, items: ["Muscle cell destruction → release of myoglobin, K⁺, H⁺", "Elevated creatine phosphokinase (CPK)", "Myoglobinuria – brown/dark urine", "Late marker: do NOT use to diagnose ACS"] },
    { title: "Acute Kidney Injury", col: C.accent, items: ["Myoglobin precipitates in tubules → ATN", "Acute tubular necrosis", "Oliguric renal failure", "May require dialysis in severe cases"] },
    { title: "Electrolyte Disturbances", col: C.textDark, items: ["Hyperkalaemia (K⁺ release from cells)", "Metabolic acidosis (H⁺ release)", "Hypocalcaemia (Ca²⁺ sequestration)", "Risk of fatal arrhythmias"] },
  ];

  comp.forEach((c, i) => addCard(s, 0.25 + i * 3.25, 1.45, 3.1, 2.7, c.title, c.col, c.items));

  // Treatment box
  s.addShape(pres.ShapeType.rect, {
    x: 0.25, y: 4.3, w: 9.5, h: 1.1,
    fill: { color: "F0FDF4" }, line: { color: C.accentGrn, size: 2 },
  });
  s.addText("Treatment of Rhabdomyolysis:", {
    x: 0.4, y: 4.35, w: 2.5, h: 0.4,
    fontSize: 11, bold: true, color: C.accentGrn, margin: 0,
  });
  s.addText([
    { text: "• Aggressive IV fluid resuscitation  ", options: {} },
    { text: "• Target urine output > 100 mL/hr until CPK < 5,000 U/L  ", options: {} },
    { text: "• Urine alkalinization (NaHCO₃) in severe cases  ", options: {} },
    { text: "• Correct electrolyte imbalances  ", options: {} },
    { text: "• Consider early dialysis if renal failure progresses", options: {} },
  ], {
    x: 0.4, y: 4.78, w: 9.2, h: 0.55,
    fontSize: 10, color: C.textDark, fontFace: "Calibri",
  });

  addFooter(s, 8, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 9 – SPECIAL SCENARIOS
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Special Scenarios", "SPECIAL CASES", C.accentAmb);

  const scenarios = [
    { title: "Open Fractures", col: C.accent, items: [
      "ACS CAN and DOES occur in open fractures",
      "Do not be falsely reassured by an open wound",
      "Fasciotomy still indicated if compartment pressure elevated",
      "Monitor ALL open fracture patients closely",
    ]},
    { title: "Altered Consciousness", col: C.accentAmb, items: [
      "Cannot assess clinical symptoms reliably",
      "Intubated, head-injured, sedated patients at risk",
      "Direct compartment pressure monitoring MANDATORY",
      "Measure all compartments; repeat serially",
    ]},
    { title: "Reperfusion after Ischaemia", col: C.accentGrn, items: [
      "Post-revascularisation oedema → ACS",
      "More severe ischaemia = higher ACS risk",
      "Ischaemia > 6 hours → prophylactic fasciotomy",
      "Post-op VAC and close monitoring",
    ]},
    { title: "Burns", col: "7C3AED", items: [
      "Circumferential third-degree burns",
      "Eschar forms non-compliant constricting casing",
      "Escharotomy required (not fasciotomy alone)",
      "Upper and lower limb compartments at risk",
    ]},
  ];

  const xs = [0.25, 2.65, 5.05, 7.45];
  scenarios.forEach((sc, i) => addCard(s, xs[i], 0.82, 2.25, 4.55, sc.title, sc.col, sc.items));

  addFooter(s, 9, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 10 – PRESSURE MONITORING TECHNIQUE
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Compartment Pressure Monitoring", "TECHNIQUE", C.textDark);

  addCard(s, 0.25, 0.78, 4.6, 2.4, "Indications", C.textDark, [
    "Diagnostic uncertainty",
    "Unconscious / sedated patients",
    "Head-injured or intubated patients",
    "Children who cannot cooperate with exam",
    "Suspicion not confirmed clinically",
  ]);

  addCard(s, 5.1, 0.78, 4.6, 2.4, "Technique", C.accentGrn, [
    "Use dedicated compartment pressure monitor or arterial line setup",
    "18-gauge needle with saline flush",
    "Insert needle into compartment at 90° to skin",
    "Measure MULTIPLE sites near (not in) fracture",
    "Measure ALL compartments of affected limb",
    "Document each compartment value",
  ]);

  // threshold table
  const tableData = [
    [
      { text: "Threshold", options: { bold: true, color: C.white, fill: C.textDark } },
      { text: "Value", options: { bold: true, color: C.white, fill: C.textDark } },
      { text: "Action", options: { bold: true, color: C.white, fill: C.textDark } },
    ],
    [
      { text: "Absolute pressure", options: {} },
      { text: "≥ 30 mmHg", options: { bold: true, color: C.accent } },
      { text: "Fasciotomy indicated", options: {} },
    ],
    [
      { text: "ΔP (DBP − compartment)", options: {} },
      { text: "≤ 30 mmHg", options: { bold: true, color: C.accent } },
      { text: "Fasciotomy indicated", options: {} },
    ],
    [
      { text: "ΔP (DBP − compartment)", options: {} },
      { text: "< 10 mmHg", options: { bold: true, color: C.accent } },
      { text: "Fasciotomy strongly indicated (some guidelines)", options: {} },
    ],
    [
      { text: "High clinical suspicion", options: {} },
      { text: "Any pressure", options: { bold: true, color: C.accentAmb } },
      { text: "Consider fasciotomy regardless", options: {} },
    ],
  ];

  s.addTable(tableData, {
    x: 0.25, y: 3.4, w: 9.5, h: 2.0,
    fontSize: 11, fontFace: "Calibri",
    colW: [3.2, 2.1, 4.2],
    border: { type: "solid", color: C.lightGray, size: 1 },
    fill: C.white,
    align: "left",
  });

  addFooter(s, 10, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 11 – OUTCOMES & PROGNOSIS
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Outcomes & Prognosis", "OUTCOMES", C.accentGrn);

  // Timeline graphic (horizontal)
  const times = [
    { label: "< 6 hrs", desc: "Fasciotomy → Good recovery, minimal functional loss", col: C.accentGrn },
    { label: "6–12 hrs", desc: "Partial muscle necrosis, some functional deficit likely", col: C.accentAmb },
    { label: "> 12 hrs", desc: "Severe necrosis, contracture, potential limb loss", col: C.accent },
    { label: "> 24 hrs", desc: "High risk: limb loss, renal failure, mortality", col: "991B1B" },
  ];

  times.forEach((t, i) => {
    const x = 0.3 + i * 2.4;
    s.addShape(pres.ShapeType.ellipse, {
      x: x + 0.55, y: 0.9, w: 1.3, h: 1.3,
      fill: { color: t.col }, line: { color: t.col },
    });
    s.addText(t.label, {
      x: x + 0.55, y: 0.9, w: 1.3, h: 1.3,
      fontSize: 13, bold: true, color: C.white, align: "center", valign: "middle", margin: 0,
    });
    s.addText(t.desc, {
      x: x + 0.1, y: 2.35, w: 2.2, h: 1.0,
      fontSize: 9.5, color: C.textDark, align: "center", fontFace: "Calibri",
    });
    // connecting line
    if (i < 3) {
      s.addShape(pres.ShapeType.line, {
        x: x + 1.85, y: 1.55, w: 0.55, h: 0,
        line: { color: C.lightGray, size: 2 },
      });
    }
  });

  addCard(s, 0.25, 3.5, 4.55, 1.85, "Complications of Delayed Diagnosis", C.accent, [
    "Volkmann's ischaemic contracture",
    "Permanent nerve damage / foot drop",
    "Muscle fibrosis and chronic pain",
    "Limb amputation",
    "Death (from AKI / multi-organ failure)",
  ]);

  addCard(s, 5.1, 3.5, 4.6, 1.85, "Factors Affecting Prognosis", C.accentGrn, [
    "Time from onset to fasciotomy (most critical)",
    "Severity of initial ischaemia",
    "Number of compartments involved",
    "Patient age and comorbidities",
    "Quality of post-operative care",
  ]);

  addFooter(s, 11, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 12 – VOLKMANN'S ISCHAEMIC CONTRACTURE
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Volkmann's Ischaemic Contracture", "COMPLICATION", C.accent);

  s.addText("The most feared late consequence of untreated or delayed ACS in the forearm / hand.", {
    x: 0.25, y: 0.82, w: 9.5, h: 0.45,
    fontSize: 12, italic: true, color: C.textDark, fontFace: "Calibri",
  });

  addCard(s, 0.25, 1.38, 3.0, 3.9, "Pathology", C.accent, [
    "Ischaemic necrosis of forearm flexors",
    "Fibrosis replaces dead muscle",
    "Tendons shorten → fixed flexion deformity",
    "Wrist: palmar flexion",
    "Fingers: flexion at MCP & IP joints",
    "Thumb: flexion & adduction",
    "Classic 'prayer deformity' posture",
  ]);

  addCard(s, 3.45, 1.38, 3.0, 3.9, "Classification", C.accentAmb, [
    "MILD: limited to fingers, corrects with wrist extension",
    "MODERATE: forearm muscles involved, partial correction",
    "SEVERE: all forearm muscles fibrosed, complete contracture",
    "May involve ulnar / median nerve palsy",
  ]);

  addCard(s, 6.65, 1.38, 3.1, 3.9, "Treatment", C.accentGrn, [
    "Prevention (fasciotomy) is key",
    "Physiotherapy / splinting (mild)",
    "Muscle slide procedure",
    "Tendon lengthening",
    "Free muscle transfer (severe)",
    "Neurolysis if nerve involvement",
    "Functional recovery often incomplete",
  ]);

  addFooter(s, 12, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 13 – KEY PEARLS & PITFALLS
// ══════════════════════════════════════════════════════════════════
{
  const s = contentSlide("Key Pearls & Pitfalls", "PEARLS", C.textDark);

  const pearls = [
    "Pain out of proportion to injury is the EARLIEST and most reliable sign — take it seriously",
    "ACS is a CLINICAL diagnosis; do not wait for pressure measurements if clinically obvious",
    "Pulselessness is an EXTREMELY late sign — arterial pulse may be present until very late",
    "ACS occurs in OPEN fractures — an open wound does NOT protect against compartment syndrome",
    "High- and low-energy injuries carry EQUAL incidence of compartment syndrome",
    "Maintain HIGH INDEX OF SUSPICION in patients with altered consciousness",
    "Do NOT elevate the limb above the heart — this reduces perfusion pressure",
    "Prophylactic fasciotomy recommended for limb ischaemia > 6 hours before revascularization",
    "Elevated CPK and myoglobinuria are LATE markers — do not use them to establish diagnosis",
  ];

  const pitfalls = [
    "Assuming open fractures cannot develop ACS",
    "Waiting for 'all 6 P's' before acting — paralysis / pulselessness = already too late",
    "Incomplete fasciotomy (partial release) → ongoing muscle necrosis",
    "Attempting early wound closure after fasciotomy",
    "Failing to measure all compartments in the affected limb",
    "Not repeating pressure measurements when clinical picture worsens",
  ];

  addCard(s, 0.25, 0.78, 5.4, 4.65, "Pearls", C.accentGrn, pearls);
  addCard(s, 5.85, 0.78, 3.9, 4.65, "Pitfalls to Avoid", C.accent, pitfalls);

  addFooter(s, 13, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// SLIDE 14 – SUMMARY
// ══════════════════════════════════════════════════════════════════
{
  const s = pres.addSlide();
  s.background = { color: C.darkBg };

  s.addShape(pres.ShapeType.rect, {
    x: 0, y: 4.5, w: 10, h: 1.125,
    fill: { color: C.accent }, line: { color: C.accent },
  });

  s.addText("Summary", {
    x: 0.5, y: 0.25, w: 9, h: 0.65,
    fontSize: 26, bold: true, color: C.white, align: "center", fontFace: "Calibri",
  });

  const summaryItems = [
    { icon: "🔑", text: "ACS = raised fascial compartment pressure → ischaemia → necrosis" },
    { icon: "⚡", text: "Most common cause: Fracture (70%) — but occurs with any limb injury" },
    { icon: "🩺", text: "Diagnose clinically: pain out of proportion + pain on passive stretch" },
    { icon: "📊", text: "Pressure monitoring for uncertain cases: Absolute ≥30 mmHg or ΔP ≤30 mmHg" },
    { icon: "🔪", text: "Definitive treatment: URGENT fasciotomy — time from onset determines outcome" },
    { icon: "⚠️", text: "Complications of delay: Volkmann's contracture, renal failure, limb loss, death" },
  ];

  const items = summaryItems.map((it, i) => ({
    text: `${it.icon}  ${it.text}`,
    options: { bullet: false, breakLine: i < summaryItems.length - 1, fontSize: 12.5, color: i % 2 === 0 ? C.white : C.lightGray },
  }));

  s.addText(items, {
    x: 0.5, y: 1.05, w: 9, h: 3.3,
    valign: "top", fontFace: "Calibri",
    lineSpacingMultiple: 1.5,
  });

  s.addText("Bailey & Love 28e · Current Surgical Therapy 14e · Rosen's Emergency Medicine · Miller's Anaesthesia 10e", {
    x: 0.5, y: 4.58, w: 9, h: 0.45,
    fontSize: 9, color: C.white, align: "center", fontFace: "Calibri",
  });

  addFooter(s, 14, TOTAL);
}

// ══════════════════════════════════════════════════════════════════
// WRITE FILE
// ══════════════════════════════════════════════════════════════════
pres.writeFile({ fileName: "/home/daytona/workspace/acs-ppt/Acute_Compartment_Syndrome.pptx" })
  .then(() => console.log("DONE: /home/daytona/workspace/acs-ppt/Acute_Compartment_Syndrome.pptx"))
  .catch(e => { console.error(e); process.exit(1); });

curl -s "https://cdn.orris.care/cdss_images/77fd2adde28c3157b1de8e7e4c3d257687bb…

cd /home/daytona/workspace/acs-ppt && node create_acs_ppt.js 2>&1

ls -lh /home/daytona/workspace/acs-ppt/Acute_Compartment_Syndrome.pptx